By Florencia López-Boo
When seated in the waiting room at the doctor’s office, sometimes we’re left scratching our heads at the receptionist’s choice of programming for the lone TV left to drone on the entire day. As a captive audience, patients have no choice but to watch the soap opera or other show that they normally wouldn’t tune in to.
With this in mind, the University of the West Indies, the Inter-American Development Bank (IDB), and the ministries of health of three Caribbean nations (Jamaica, St. Lucia and Antigua) decided to study what would happen if they created videos and a parenting program with specific interventions for mothers in the waiting rooms at pediatric clinics. In addition, Jamaica adapted an existing home-visiting program for psychosocial stimulation, previously evaluated by Sally Grantham McGregor and the co-authors, to increase the program’s feasibility at scale by reducing the frequency and duration of visits and the amount of materials provided. The following is a summary of what they discovered and published in the impact assessment paper Delivering Parenting Interventions through Health Services in the Caribbean: Impact, Acceptability and Costs (Spanish version available here):
1. The children showed significant gains in cognitive development, while their mothers had improved understanding of child development and parenting knowledge.
2. An analysis of the two types of interventions in Jamaica found that both (separately) benefited cognitive development considerably. What’s interesting is that these benefits were achieved without additional contact between the mothers and the health center. Innovation in terms of the combined use of videos, demonstration and practice may be the reason why mothers participated actively, thereby generating benefits for both them and their children.
3. Qualitative interviews analyzed in the paper show that the interventions yielded benefits for mothers and health care staff as well as for children. The main implementation challenges reported were staff workload and group management.
4. It is important to note that conservative calculations yielded a cost-benefit ratio of 5.3 for the health center intervention and 3.8 for the home visit intervention, indicating that the benefits of this investment far outweighed the costs.
Lastly, this strategy of working with parents and children through health services in the Caribbean has the great advantage of being able to reach many families, due to the excellent coverage of the health system and compliance with health visits in this region.
The Ingredients of the Experiment at Health Centers
Duration: The intervention used group delivery during five routine health center visits from ages 3 to 18 months. Community health workers spent an average of 15 minutes on the group activity in the waiting room, while nurses spent an average of two minutes on the activity in the clinic.
- In the waiting room: While mothers waited to be seen, videos were shown with messages about child development. A community health worker discussed the films’ messages with the mothers and demonstrated concrete activities based on those messages, e.g., how to make homemade toys.
- In the clinic: Nurses handed out cards with messages that reinforced the videos, as well as some play materials (puzzles, picture books, etc.).
Why This Is Important
The IDB’s 2015 flagship publication The Early Years: Child Well-being and the Role of Public Policy shows that a large number of children in Latin America and the Caribbean present serious developmental deficits. These deficits are most acute in the cognitive and language domains and are particularly pronounced in children living in poverty.
Interventions aimed at improving child health and nutrition are just one part of what is needed to improve child development. These children also need interventions that promote quality interactions with their parents and generate learning opportunities at home.
Chapter three of The Early Years, entitled “Family First,” examines rigorous evaluations of small- and medium-scale interventions consisting of home-based, early psychosocial stimulation. The integration of these types of interventions with health and nutrition has been recommended by several international organizations; however, this recommendation was made on the basis of limited information on effectiveness and feasibility. Do similar interventions exist in your country? What aspects should public health officials consider when scaling up these types of programs? Tell us in the comments section below or on Twitter (@BIDgente).
Florencia Lopez Boo is a senior social protection economist with the Social Protection and Health Division of the Inter-American Development Bank.